Folate pregnancy

In 1992, the US Public Health Service issued a recommendation that all women capable of becoming pregnant should consume 400 mcg of folic acid daily in order to avoid the risk of neural tube defects in their babies. Around 50 per cent of neural tube defects may be preventable by increasing folate intakes. Eating foods naturally high in folic acid, eating fortified foods and taking supplements are good ways of increasing folic acid intake to recommended levels. Adequate consumption of folic acid should begin before and continue during at least the first four weeks after conception when the fetal neural tube is being formed.

Research suggests that in women who have previously had a child with a neural tube defect, folic acid in doses of up to 4 mg daily can reduce the risk of recurrence by about 70 per cent. This is something to be discussed with a doctor as such large amounts of folic acid are only available on prescription.

Studies suggest that the levels of folate necessary to prevent neural tube defects are more easily derived from fortified foods or supplements than from natural food sources alone. In an editorial in the New England Journal of Medicine, Godfrey Oakley MD of the Centers for Disease Control in Atlanta commented that "anyone who chooses to counsel a woman to consume 400 mcg of food-derived folate rather than 400 mcg of supplemental folic acid will be recommending a strategy that has not been proved to prevent birth defects and that leads to lower blood folate concentrations." Many experts recommend folic acid supplements and a diet rich in folates for women who are hoping to beccome pregnant.

In a study published in The Lancet in 1996, Irish researchers tested the an additional 400 mcg per day); dietary folate (an additional 400 mcg per day); dietary advice, and control. The results showed that red blood cell folate concentrations increased significantly in the groups taking folic acid supplements or food fortified with folic acid. The researchers concluded that advice to women to consume folate-rich foods as the only way to boost folate levels is misleading.

In another study also published in The Lancet, researchers studied blood folic acid levels in 95 women in order to determine the minimum effective dose of folic acid for food fortification necessary to prevent neural tube defects. The women in the study were divided into four groups. One group received no folic acid while the other groups got doses of 100,200 and 400 mcg daily. After six months, the researchers found that women taking 100 mcg daily had blood folic acid levels sufficient to prevent 22 per cent of neural tube defects. Those taking 200 mcg had a 41 prevention level and 400 mcg gave a 47 per cent prevention level. The researchers felt that as between 50 and 70 per cent of neural tube defects are thought to be preventable by folic acid, the reduction achieved by an additional 100 mcg per day would be substantial.

A trial of the effects of vitamin supplements containing folate supplements on the incidence of neural tube defects involving over 4700 women was carried out in Hungary. In the women who did not receive folic acid there were six babies born with neural tube defects. In the group receiving the supplements, there were none.

Cardiovascular disease

Folic acid supplements may reduce the risk of coronary heart disease by reducing homocysteine levels. In a paper published in the British Medical Journal in 1998, researchers analyzed the results of randomized controlled trials that assessed the effects of folic acid-based supplements on blood homocysteine

concentrations. The data included that from 1114 people in 12 trials. They found that 0.5 to 5 mg folic acid daily reduced blood homocysteine concentrations by 25 per cent.

In 1998, researchers at the Harvard School of Public Health published data from the Nurses Health Study which showed that intake of folate and vitamin B6 above the current recommended dietary allowance is important in the prevention of coronary heart disease among women. The study involved 80 082 women with no cardiovascular disease, cancer, high cholesterol or diabetes on entry to the study. During a 14 year period there were 658 cases of non-fatal heart attack and 281 cases of fatal coronary heart disease. Women in the highest folate intake group had around a 30 per cent reduced risk of disease. The risk of coronary heart disease was reduced by about 25 per cent in women who regularly used multiple vitamins.

Those with the highest homocysteine levels may respond best to increases in folic acid intake, and above a certain level of intake, increasing folic acid may not affect homocysteine levels. In a 1997 Irish study, researchers assessed the effects of various doses of supplements on homocysteine levels. Of the three folic acid doses, 200 mcg appeared to be as effective as 400 mcg, while 100 did not lower levels sufficiently.

Cancer

Several studies suggest that folic acid supplements can help to reduce the risk of cancerous changes in several areas such as the cervix, lung and gastrointestinal tract.

Colorectal cancer

In a study published in 1997, researchers at the Cleveland Clinic investigated the links between folate and cancerous changes in 98 patients with ulcerative colitis. Patients taking folic acid supplements had a 30 per cent lower risk of developing cancerous changes in the bowel. The lower the folate levels, the more advanced the degree of cancerous changes in the cells. In a 1997 Italian study, researchers also studied the effects of folate supplements on pre-cancerous cell changes in ulcerative colitis. The results showed that folate reduced these changes. Folic acid may also help to prevent the pre-cancerous changes in lung tissue caused by smoking.

Cervical dysplasia

Folic acid supplementation may protect abnormal cells from becoming cancerous and may reverse cervical dysplasia in some cases. A 1996 study done at the University of Alabama at Birmingham suggests that supplements may be useful in preventing the initial changes but do not appear to affect the progress of established disease. Some researchers have found a higher risk of abnormalities in cervical tissue in women using oral contraceptives and suggest that folic acid supplements are beneficial in preventing cervical dysplasia in these women.

Anemia

Folic acid is used to treat folic acid deficiency anemia and for supplementation in those suffering from sickle cell disease.

Mental function

Many psychiatric patients show folic acid deficiency, especially those suffering from depression. Supplements may be particularly beneficial in elderly people suffering from impaired mental function. This may be due to effects on neurotransmitters such as serotonin and dopamine.

Other uses

Folic acid supplements are given to those taking the drug, methotrexate, to prevent toxic side effects. Folic acid may be of value in the treatment of gout and may also shorten the recovery time from hepatitis. Supplements may be useful in the treatment of osteoporosis as increased homocysteine levels may lead to defective bone formation. Folic acid may also be useful in improving skin condition in vitiligo. Folic acid mouthwash may be useful in the treatment of periodontal disease and gum inflammation.